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What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis


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Green exercise is activity in the presence of nature. Evidence shows it leads to positive short and long-term health outcomes. This multistudy analysis assessed the best regime of dose(s) of acute exposure to green exercise required to improve self-esteem and mood (indicators of mental health). The research used meta-analysis methodology to analyze 10 UK studies involving 1252 participants. Outcomes were identified through a priori subgroup analyses, and dose-responses were assessed for exercise intensity and exposure duration. Other subgroup analyses included gender, age group, starting health status, and type of habitat. The overall effect size for improved self-esteem was d = 0.46 (CI 0.34-0.59, p < 0.00001) and for mood d = 0.54 (CI 0.38-0.69, p < 0.00001). Dose responses for both intensity and duration showed large benefits from short engagements in green exercise, and then diminishing but still positive returns. Every green environment improved both self-esteem and mood; the presence of water generated greater effects. Both men and women had similar improvements in self-esteem after green exercise, though men showed a difference for mood. Age groups: for self-esteem, the greatest change was in the youngest, with diminishing effects with age; for mood, the least change was in the young and old. The mentally ill had one of the greatest self-esteem improvements. This study confirms that the environment provides an important health service.
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What is the Best Dose of Nature
and Green Exercise for Improving
Mental Health? A Multi-Study
Interdisciplinary Centre for Environment and Society,
Department of Biological Sciences, University of Essex,
Colchester CO4 3SQ, U.K.
Received October 21, 2009. Revised manuscript received
March 12, 2010. Accepted March 15, 2010.
Green exercise is activity in the presence of nature. Evidence
shows it leads to positive short and long-term health
outcomes. This multistudy analysis assessed the best regime
of dose(s) of acute exposure to green exercise required to improve
self-esteem and mood (indicators of mental health). The
research used meta-analysis methodology to analyze 10 UK
studies involving 1252 participants. Outcomes were identified
through a priori subgroup analyses, and dose-responses were
assessed for exercise intensity and exposure duration. Other
subgroup analyses included gender, age group, starting health
status, and type of habitat. The overall effect size for improved
self-esteem was d)0.46 (CI 0.34-0.59, p<0.00001) and for
mood d)0.54 (CI 0.38-0.69, p<0.00001). Dose responses
for both intensity and duration showed large benefits from short
engagements in green exercise, and then diminishing but
still positive returns. Every green environment improved both self-
esteem and mood; the presence of water generated greater
effects. Both men and women had similar improvements in self-
esteem after green exercise, though men showed a difference
for mood. Age groups: for self-esteem, the greatest change
was in the youngest, with diminishing effects with age; for mood,
the least change was in the young and old. The mentally ill
had one of the greatest self-esteem improvements. This study
confirms that the environment provides an important health
Ecosystems provide important services driven by provision-
ing, regulation, and support functions (1, 2). It is clear they
also provide a health service arising from direct activities in
contact with nature. Recognition of the potential contribution
of natural ecosystems to human population health may
contribute to addressing problems associated with inactivity,
obesity, mental ill-health, and other chronic diseases. Many
of these urgent health challenges are also connected to
sedentary and indoor lifestyles (3, 4). Physical inactivity results
in 1.9 million deaths worldwide annually (5), roughly 1 in 25
of all deaths. Preindustrial humans expend some 1000 kcal
on activity per day, whereas for modern humans the mean
is 300 kcal (6). Inactivity increases the likelihood of obesity
and reduces life expectancy. Such physical inactivity tracks
from childhood, and is a key risk factor in many chronic
diseases of later life (7). Mental health disorders are now
known to affect most people at some point in their lives,
with 16% of the general population affected at any given
time (8, 9). As aging populations will put additional pressure
on health services, it is becoming increasingly urgent that all
sectors of the population undertake and sustain healthy
behaviors as early in life as possible (10).
Evidence shows that exposure to natural places can lead
to positive mental health outcomes, whether a view of nature
from a window, being within natural places, or exercising in
these environments (11–13). At the population level, there
are associations between health and proximity to greenspaces
(14). Thus, green space is important for mental health and
regular engagement is linked with longevity and decreased
risk of mental ill-health (15). Yet as more than half of the
world’s population now live in urban settlements, daily
environmental contact is becoming rarer (16), suggesting
the growing importance of access to local greenspace for
both quality of life and the sustainability of towns and cities
(17, 18). It is also well-known that physical activity improves
both physical and mental health of all age groups (19–22).
Thus “green exercise”, consisting of activity in green places
(in the presence of nature), is predicted to generate positive
health outcomes (23–26), accrue ecological knowledge
(21, 22, 27, 28), foster social bonds (29), and influence
behavioral choices (11, 24–26, 30, 31). In economic terms,
there should be cost savings if natural places are both
protected (32, 33) and used as sites for activity, thus generating
health benefits.
Achieving good mental health is not just a reflection of
the absence of disease or disability. It comprises a balance
between self-satisfaction, independence, capability and
competency, achieving potential, and coping well with stress
and adversity (34). Both self-esteem and mood are short-
and long-term determinants of mental health: both are
commonly assessed in green-exercise research. Self-esteem
is an evaluation of a person’s sense of worth or value (35),
and there are strong positive correlations between self-esteem
and health (28, 36). There are further inverse relationships
between self-esteem and mental health (e.g., depression,
social anxiety, loneliness, alienation) (35). High levels of self-
esteem are associated with healthy behaviors, such as healthy
eating, participating in physical activities, not smoking, and
lower suicide risks (37).
Mood is an integral component of daily life and strongly
influences feelings of happiness, appreciating the moment,
coping with stressful situations, and quality of life (38, 39).
Mood is linked with physical health and is known to affect
the immune system and the onset of certain diseases (40).
Acute changes in mood are generally maintained for 2-4h
post exercise, though this relatively short duration of
enhanced mood has a positive influence on quality of life
including more social interaction, improved productivity,
and better behavioral choices (39–41). Regular exercise
contributes to sustained chronic changes in mood. Thus,
both self-esteem and mood are regularly used to assess the
outcomes of acute-exposures to nature-based interventions.
However, health as an environmental service remains hard
to value (42–44), and these scientific findings do not yet
appear to have influenced the planning of urban and rural
environments, priorities for public health, social care and
youth offender programs, nor recommendations for the
emergence of sustainable lifestyles. The evidence to date
incorporates different methodologies and variables mea-
sured, along with international differences in typologies of
greenspaces, length of activity programs, and primary
* Corresponding author phone: +44-1206-873323; e-mail:jpretty@
Environ. Sci. Technol. 2010, 44, 3947–3955
10.1021/es903183r 2010 American Chemical Society VOL. 44, NO. 10, 2010 / ENVIRONMENTAL SCIENCE & TECHNOLOGY 93947
Published on Web 03/25/2010
research questions. Uncertainties remain on the ideal
duration and intensity of nature-based activities to improve
mental health for different cohorts of people. It is also unclear
how recommendations should vary according to participant
characteristics. The purpose of this research was thus to assess
the best regime of dose(s) of acute exposure to green exercise
required to improve self-esteem and mood. The term “dose
of green exercise” represents the linked relationships between
duration of exposure, intensity of activity, and type of
Detailed research questions relate to physical activities
(duration and intensity), types of green places, and participant
characteristics (age, sex, health status): 1. How does exercise
duration affect self-esteem and mood?; 2. How does exercise
intensity affect self-esteem and mood?; 3. How do different
green habitats (e.g., urban green space, countryside, water-
side, wilderness, woodlands) affect self-esteem and mood?
4. What are the measurable differences according to selected
participant characteristics (e.g., children, adult, elderly;
female, male)?
We thus conducted a multistudy analysis of available data
using standardized meta-analysis methods to assess the
impact of green exercise on self-esteem and mood. This
enabled us to determine the most effective regime(s) for a
dose of acute green exercise. The recommended dose is based
on the combined benefits of both variables and does not
assess the separate contributions of nature and physical
activity on mental health.
Materials and Methods
Study Selection. Ten studies undertaken by the University
of Essex over the past six years were selected for inclusion.
The multistudy analysis was limited to these studies because
all used identical measurement tools to analyze changes in
self-esteem and mood after an acute exposure to green
exercise. However, to ensure validity of the overall analysis
standardized meta-analysis methods were used.
Self-esteem and mood measures were chosen as they are
state measures and can be easily manipulated in the short
term. They are also early indicators of long-term disease risk
and have implications for health behaviors, motivations, and
lifestyle choices. None of the studies used randomized
controlled trials or incorporated control groups where
participants were exposed to nature without exercising or
exercised in nongreen environments. All 1252 participants
were self-selecting using an opportunistic sampling meth-
odology and took part only in one study. We had full access
to all primary data, including pre- and post- mean values,
sample sizes, paired groups t-value, effect directions and
information on the nature of the intervention, participants
and location type (Table 1). This study does not therefore
include a large variety of studies from different research
Self-Esteem and Mood Measures. The Rosenberg Self-
Esteem Scale (RSE) is the most widely used and popular
self-esteem measure (45, 46). Many researchers regard the
scale as the standard against which other measures of self-
esteem should be compared. In all of the studies self-esteem
was measured immediately pre- and postactivity or inter-
vention using the one-page 10-item RSE scale.
The instrument used to quantify changes in mood was
the Profile of Mood States (POMS) standardized short-form
(47). POMS is the primary instrument for measuring mood
in studies of mood states and exercise (48, 49). Measurements
were taken in all these studies immediately pre- and
postactivity or intervention.
Statistical Analysis. Standardised meta-analysis meth-
odologies were used to assess changes in self-esteem and
mood data pre- and post- green exercise interventions.
Summary statistics represented the mean difference between
the pre- and postintervention values for both self-esteem
and total mood disturbance (TMD) (46, 47). The Compre-
hensive Meta-Analysis Version 2.0 was used for analysis. Data
were pooled to calculate an overall intervention effect
estimate. This represents the weighted average of the
combined individual intervention effects and the inverse-
variance method was used to assign weights to each study.
Thus, larger studies with smaller standard errors were given
more weight than smaller studies with larger standard errors.
This reduced the imprecision of the pooled-effect estimate.
It was assumed that the various studies involved in the
analysis were measuring different but related intervention
effects, and thus the combined intervention effect estimates
were calculated using a random-effects model meta-analysis
(50, 51). A funnel plot of precision and the “trim and fill” output
was used to inspect bias, and 95% confidence intervals were
calculated on the basis of the standard error of the pooled
intervention effect. Statistical significance was set at p<0.05.
TABLE 1.Descriptive Data on the Green Exercise Interventions Included in the Meta-Analysis
participants type of activities type of environments cohort
1 256 cycling, gardening,
walking, fishing, boating,
countryside/farmland, forest
and woodland, urban green,
individuals choosing to
engage in GE activities
2 153 walking countryside/farmland, forest
and woodland, wild habitats
individuals at NT sites
3 38 farming activities countryside/farmland visitors to care farms
4 11 gardening forest and woodland students
5 57 walking countryside/farmland, forest
and woodland, waterside, wild
members of local mind
6 86 walking forest and woodland individuals choosing to
engage in GE activities
7 447 walking urban green individuals at urban flower
8 59 farming activities countryside/farmland visitors to care farms
9 10 walking, water based (sailing) wild habitats, waterside young offenders
10 135 gardening urban green individuals responsible for
Note: These studies were conducted with (1) Countryside Recreation Network, (2) National Trust, (3) National Care
Farming Initiative, (4) University of Essex, (5) Mind, (6) Highwoods Country Park, (7) Royal Horticultural Society, (8) LEAF,
(9) Wilderness Foundation, and (10) local allotment societies.
A statistical test for within-group heterogeneity assessed whether
observed differences were due to chance alone. The chi-squared
Q statistic was calculated using Q/(k-1), where k is the number
of studies in the meta-analysis (52). The I2statistic was calculated
using both Q statistic and degrees of freedom (53).
To investigate whether the intervention effect varied with
differing cohorts, type of green space, exposure duration or
exercise intensity, a series of predefined a priori subgroup
analyses were conducted. This allowed the exploration of
possible sources of heterogeneity by identifying modifiers.
Selection was based on causal mechanisms, magnitude of
effects and statistical significance (54). In accordance with
recommendations, all subgroup analyses were justified by
existing knowledge of the relationship between green exercise
and self-esteem/mood. The subgroup analyses identified
were 1. exposure duration: 5 min, 10-60 min, half-day, whole
day; 2. exercise intensity: low (<3 METs (metabolic equiva-
lent)), moderate (3-6 METs-) and vigorous (>6 METs) (55);
3. type of green space: urban green, countryside/farmland,
forest/woodland, waterside, and wilderness-type habitats;
4. gender: female or male; 5. age groups: <30 years, 31-50,
51-70, and >70 years of age; 6. starting health status: healthy
or with existing mental health problems.
Effect of Green Exercise. The multistudy analysis of differ-
ences in self-esteem and mood before and after green exercise
are shown in Figures 1a and b. The overall effect size for
change in self-esteem was d)0.46 (CI 0.34-0.59, p<0.00001)
and significant heterogeneity was found between estimates
of self-esteem (Q)29.83, p<0.00001). The overall effect size
for change in TMD was d)0.54 (CI 0.38-0.69, p<0.00001)
and again there was significant heterogeneity for TMD (Q)
45.95, p<0.00001). Effect size was thus higher for mood than
self-esteem. These changes represented improvements in
both self-esteem and mood. Based on the heterogeneity
findings six subgroup analyses were conducted.
Figure 2a and b illustrate dose-responses for duration of
exposure: both self-esteem and mood show distinct U shapes.
Greatest changes come from 5 min of activity, and thus
suggest these psychological measures are immediately
increased by green exercise. The changes are lower for 10-60
min and half-day, but rise again for the whole day duration.
Figure 3a and b show dose-responses for exercise intensity.
For self-esteem, the greatest change is for light activity and
then declines with growing intensity. For mood, the response
is again greatest for light intensity, declining to the lowest
for moderate, and then rises again for vigorous activity.
Figure 4a and b show effect sizes for five categories of
habitat or green space. There are no great differences for
urban space, countryside and woodland habitats. For both
measures, waterside habitats showed the greatest changes.
Green places improve self-esteem and mood (mean of d
FIGURE 1. a and b. Meta-analysis of studies showing effect sizes and 95% CIs for changes in self-esteem and TMD after
participation in green exercise activities (change in self-esteem was calculated as the difference between the pre and
postintervention scores).
values 0.44 and 0.56); however, green spaces with water shows
a larger difference (increase of 0.29 for self-esteem and 0.19
for mood).
Table 2 shows the results where there are binary groups
(male or female; healthy or mentally ill). All subgroup analyses
reported significant improvements in self-esteem and mood,
with effect sizes ranging from 0.38 (small) to 0.68 (moderate-
large). Changes in self-esteem and mood were similar for
both men and women. Healthy participants showed a smaller
change in self-esteem than those with self-declared mental
health problems (d)0.41 compared with d)0.68, p<0.0001),
though there was only a small difference for mood (d)0.53
compared with d)0.56). Table 2 shows significant within-
group heterogeneity based on starting health status (both
mood and self-esteem) and sex (mood only).
Figure 5a and b show the effect sizes over four age groups
(<30, 31-50, 51-70, and >70 years). The improvement in
self-esteem declines with aging (the greatest change is for
the youngest age group), whereas mood shows an inverted
U-curve with greatest changes in the midage groups.
The results show acute short-term exposures to facilitated
green exercise improves both self-esteem and mood ir-
respective of duration, intensity, location, gender, age, and
health status. The six subgroup analyses suggest important
specific recommendations for the most effective dose of
nature and green exercise. 1. Exposure duration: both self-
esteem and mood showed greatest changes for the least
duration (5 min), both showed smaller positive improvements
for <1 h and half-day activities, and both increased for whole-
day activities. This suggests that there is an immediate effect
obtained from the start of green exercise. Whole-day activities
are likely to be qualitatively different activities, involving in
some cases camping overnight and in others significant
conservation achievements. 2. Exercise intensity: self-esteem
improvements declined with growing intensity of activity,
and mood improvements were greatest for light and vigorous
activity. This suggests that there is a health benefit from any
short engagement in green exercise. 3. Type of green space:
all green environments improved both self-esteem and mood;
the presence of water generated greater improvements.
Although participants should be encouraged to undertake
outdoor activities in both rural and urban environments,
spending time near waterside (e.g., beach or river) or
participating in water-based activities may give a greater
benefit. 4. Sex: both men and women reported similar
improvements in self-esteem after green exercise, though
men showed a difference for mood. 5. Age groups: for self-
esteem, the greatest change was in the youngest category,
FIGURE 2. a: Dose response data for the effect of exposure duration on self-esteem. b: Dose response data for the effect of exposure
duration on TMD.
with diminishing effects with age; for mood, the least change
was for the young and old. This suggests that younger people
will see more self-esteem improvements, and the middle-
aged from mood. The over-70 age group experienced the
least change, perhaps because those sampled were already
experiencing good mental health and further improvements
were limited. 6. Starting health status: the mentally ill had
one of the greatest changes for self-esteem improvements.
This suggests that the mentally ill should be encouraged to
undertake green exercise.
Exposure to nature via green exercise can thus be
conceived of as a readily available therapy with no obvious
side effects (56). These findings indicate that dose responses
for both intensity and duration showed large benefits from
short engagements in green exercise, and then diminishing
but still positive returns. The findings also suggest that those
who are currently sedentary, nonactive, and/or mentally
unwell would accrue health benefits if they were able to
undertake regular, short-duration physical activity in ac-
cessible (probably nearby) green space. Such doses of nature
will contribute to immediate mental health benefits. As with
smoking, giving up inactivity and urban-only living results
in immediate and positive health outcomes, even from short-
duration and light activity such as walking. The findings from
this multistudy analysis suggest the need to undertake larger-
scale and randomized studies of different cohorts over long
time-frames to explore the dose of green exercise further.
All studies included in this multistudy analysis involve
exercise in green environments. The combined benefits are
thus assessed but the relative contributions of each com-
ponent are still unknown. Thus, there is also a need for a
field-based controlled study to analyze the benefits of each
element and assess whether there are any synergistic
outcomes. This has been demonstrated in a controlled
laboratory environment involving simulated green exercise
(12), but evidence is limited in the field. Overall mood effect
sizes for green exercise in this study are slightly larger (d)
0.54) compared with exercise in nongreen environments (d
)0.49) reported in other studies (57), although future research
is still needed to compare different exercising environments.
The findings here are based on short-term exposures to
single interventions. There remains a need for longitudinal
multicohort studies to track changes over time. Important
questions remain on how long the enhanced mood lasts once
activity has finished, and whether there are accumulative
effects following repeat exposures. The findings comprise
studies conducted by one University; thus once other national
data becomes available future meta-analyses will be more
cross-sectional. The 10 studies were also analyzed over a
period of six years, so self-esteem and mood may have been
manipulated by extraneous variables which could not be
controlled for. However, the outcomes do suggest a new
priority for frontline environmental and health professionalss
a regime of doses of nature may be prescribed for anyone,
but will have a greater effect for the inactive or stressed and
mentally ill, or at presurgery (58) or for recovery (59).
Employers, for example, could encourage staff in stressful
workplaces to take a short walk at lunchtime in the nearest
FIGURE 3. a: Dose response data for the effect of exercise intensity on self-esteem. b: Dose response data for the effect of exercise
intensity on TMD.
park to improve mental health, which may in turn affect
productivity (60).A particular focus should be on children:
regular outdoor play brings immediate health benefits, and
may instill healthy behaviors early in life (61). Childhood
social and economic conditions also predict adult health
status (62), and outdoor free-play is vital for development
and cognitive skills (63, 64). Given the therapeutic affects of
green exercise (65), youth offender teams should engage
certain groups of young people more in outdoor programs.
Health inequalities could be reduced if attention were also
given to the importance of urban design for both private
dwellings and public institutions such as schools, care homes
and hospitals (14).
Although good self-esteem and mood are known to be
protective against future long-term health threats, these
mental health measures should also be assessed in conjunc-
tion with a range of further health markers, such as blood
pressure, cholesterol, stress hormones (e.g., cortisol), and
inflammatory markers (e.g., C-RP). This research has not
assessed the benefits of undertaking activities with other
people (the benefits of social capital), nor the benefits of
connections with animals (28, 66). It also does not assess
how short-term changes to self-esteem and mood could lead
to long-term changes in knowledge and behavior, such as
the possible conservation benefits arising from more people
engaging in outdoor activity, and therefore coming to know
FIGURE 4. a: The effect of typology of green space on self-esteem. b: The effect of typology of green space on TMD.
TABLE 2.Summary of Effect Sizes for Two Sub-Groups Where These Are Divided into Only Two Categories (Gender and Health
sub-group measure category dvalue 95% CI P N Q P
female 0.38 0.23 -0.54 <0.0001 363 14.52 0.07
male 0.42 0.32 -0.53 <0.0001 377 7.82 0.45
combined 0.41 0.33 -0.50 <0.0001 740 23.40 0.14
female 0.49 0.33 -0.64 <0.0001 408 15.00 0.06
male 0.55 0.25 -0.85 <0.0001 387 42.48 <0.0001
combined 0.50 0.36 -0.64 <0.0001 795 58.45 <0.0001
starting health status
healthy 0.41 0.28 -0.55 <0.0001 1076 22.13 <0.001
mental ill-health 0.68 0.42 -0.94 <0.0001 105 2.73 0.26
combined 0.46 0.40 -0.52 <0.0001 1181 29.83 <0.0001
healthy 0.53 0.34 -0.71 <0.0001 1146 40.52 <0.0001
mental ill-health 0.56 0.19 -0.93 0.003 99 4.99 0.08
combined 0.53 0.37 -0.70 <0.0001 1245 45.95 <0.0001
more about natural habitats, and whether such engagements
with nature could lead to changes in food consumption
behavior. Contact with nature might thus promote more pro-
environmental behavior and attitudes.
This study using meta-analysis methods suggests that
attention should be given to developing the use of green
exercise as a therapeutic intervention (green care), that
planners and architects should improve access to green space
(green design), and that children should be given opportuni-
ties to learn in outdoor settings (green education). Some of
the substantial mental health challenges facing society (9, 60)
and physical challenges arising from modern diets and
sedentary lifestyles (8, 67, 68) could be addressed by increased
forms of activity in green places.
A challenge for policy makers is that policy recom-
mendations on physical activity are easily stated but rarely
adopted widely. The economic benefits are hard to calculate,
though could be substantial (42, 67). Policy frameworks that
suggest active living (69, 70) point to the need for changes
to physical, social and natural environments, and are more
likely to be effective if physical activity becomes an inevitable
part of life rather than a matter of daily choice (71). Simple
prescriptions are unlikely to be adopted by whole populations
unless supported by shifts in urban design, transport policy,
support for social care, parenting, and patients’ expectations
of their doctors. Accessing natural places for their health as
well as environmental services may aid these transitions.
We are grateful to Gavin Sandercock for suggestions on the
methods for meta-analysis, to Rachel Hine, Jo Roberts,
Murray Griffin, Marion Nolan-Ericsson, Graeme Willis, and
Sarah Pilgrim for some of the primary data collection in the
analysed studies, and to four referees for helpful comments
on an earlier version of this paper. We report that there are
no conflicts of interest.
Supporting Information Available
A brief summary of the instruments used to measure self-
esteem (Rosenberg Self-Esteem Scale) and mood (Profile of
Mood States). This material is available free of charge via the
Internet at
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... Built environment factors (e.g., greenspace) may alleviate the negative mental emotions and physical exhaustion caused by prolonged NPIs enforcement. Greenspaces not only improve recovery from mental fatigue but also promote physical activity, which could help maintain better mood states (Barton & Pretty, 2010;Berger & Motl, 2000;Fox, 1999) and promote positive lifestyles and emotions (Hogan, Catalino, Mata, & Fredrickson, 2015). These benefits could contribute to reducing behavioral fatigue and strengthen motivation to comply with NPIs. ...
... Accumulating evidence shows that people living near greenspaces have higher physical activity and health levels (Akpinar, 2016;Kaczynski, Potwarka, Smale, & Havitz, 2009;Schipperijn, Bentsen, Troelsen, Toftager, & Stigsdotter, 2013;Yang, Lu, & Jiang, 2022). Sufficient physical activity contributes to physical health by reducing the risk of obesity and cardiovascular disease and improves mental health issues, such as stress, anxiety, and depression, thus promoting well-being (Barton & Pretty, 2010;de Wit et al., 2010;Hansmann, Hug, & Seeland, 2007;Harris, Cronkite, & Moos, 2006). People are more likely to maintain a positive emotional state and maintain self-discipline for NPIs behaviors. ...
Non-pharmaceutical interventions (NPIs) remain some of the most effective measures for coping with the ever-changing coronavirus disease 2019 (COVID-19) pandemic. Pandemic fatigue, which manifests as the declined willingness to follow the recommended protective behaviors (e.g., keeping social distance policies, wearing masks), has commanded increasing attention from researchers and policymakers after the prolonged NPIs and COVID-19 worldwide. However, long-term changes in pandemic fatigue are not well understood, especially amidst the ever-changing pandemic landscape. Built environment factors have been shown to positively affect mental and physical health, but it is still unclear whether built environments can moderate pandemic fatigue. In this study, we used Google mobility data to investigate longitudinal trends of pandemic fatigue in social distance since the onset of NPIs enforcement in the United States. The results indicated that pandemic fatigue continuously worsened over nearly two years of NPIs implementation, and a sharp increase occurred after the vaccination program began. Additionally, we detected a significant moderation effect of greenspace and urbanicity levels on pandemic fatigue. People living in areas with high levels of greenness or urbanicity experienced lower levels of pandemic fatigue. These findings not only shed new light on the effects of greenness and urbanicity on COVID-19 pandemic fatigue, but also provide evidence for developing more tailored and effective strategies to cope with pandemic fatigue.
... The negative side effects of strictly material consumption on factors critical to well-being (Pretty et al. 2016) can help explain the gap between GDP growth and stable well-being that usually characterises rich countries. On the other hand, environmentally sustainable consumption, including non-material consumption, can improve individual well-being and the supply of renewable natural, social and human capital resources (Pretty 2013;Barton and Pretty 2010). ...
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This paper looks at the concept of well-being from the perspective that a way of producing well-being is sustainable if it is also efficient, such being able to last over time. The paper gets its value from considering how well-being is produced and from assessing whether OECD countries are making the most of their resources or should revise their production processes. The data envelopment analysis is performed on all 37 OECD countries using the OECD Better Life Index variables with the aim of evaluating both technical and social efficiency in producing well-being. This allows both to assess how many countries are efficient in exploiting their resources and to consider social and environmental externalities as inputs and not only as an unavoidable consequence of the production process. High well-being countries are not always efficient at producing those levels of well-being. The poorest countries show the worst social efficiency scores: in the early stages of development, countries are focused on improving technical efficiency and, only later, on issues that are not merely economic, such as environmental and social costs.
... From a physical point of view, peri-urban forests contribute to facilitating illness recovery and reducing sick leave, improving attention capacity, reducing several conditions including obesity and other various diseases, and in general ameliorating visitors' physical wellbeing [13][14][15]. From a psychological and mental point of view, an urban population can benefit from the contribution of peri-urban forests in reducing stress and anxiety, improving mental health, increasing pain tolerance, and supporting psychological wellbeing in general [16][17][18]. ...
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Peri-urban forests are complex systems capable of providing amenity and scenic values as well as recreational opportunities for citizens. From early 2020, national governments have promulgated restrictions, requiring citizens to adopt a new lifestyle to counter the COVID-19 outbreak. This study aimed to understand if citizens’ behaviors and attitudes in the use of peri-urban forests are changing due to COVID-19 restrictions. Methodologically, a questionnaire survey was carried out, adopting a systematic sampling method. Two peri-urban forests were chosen as study areas: the first one was close to the town of Trento in the Alps (Monte Marzola), and the second one was in the proximity of the city of Florence (Monte Morello). At the end of data collection, 281 questionnaires were collected and processed. The results showed an increase in visits to peri-urban forests during the COVID-19 pandemic (36.4% of visitors in Monte Marzola and 17.1% in Monte Morello, respectively) with the aim of satisfying the need for relaxation and contact with nature. However, the use of peri-urban forests in times of crisis has been quite different in the two contexts: the visitors of Monte Marzola evidenced the role of a forest as a place where they can satisfy their need to play sports (mean value 4.53 in a five-point Likert scale), while Monte Morello forest was considered by visitors to be a place where the demand for companionship was fulfilled (mean value 4.27).
... : The participant walks around the site as usual for 5 minutes ⑤[55][56] . ① The experiment was approved by the Experiment Ethic Committee of the authors' university. ...
... Overall, natural environments can have a positive impact on health and well-being [27][28][29]. Being outdoors in nature can be, in general, health-promoting [28]. Furthermore, being outdoors can stimulate all the senses [23,30,31], increase the feeling of freedom and have a positive effect on the immune system [31]. ...
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In times of social and ecological crises, such as COVID-19 with lockdowns and implementing the impact of climate change, mental health degrades. Being outdoors in nature can be health-promoting, can decrease depression, and increase mental well-being. This pilot study investigated the relationships between nature-based therapy, mental health, and individuals’ connectedness to nature. We hypothesize that nature-based therapy has a positive impact on individual mental health and connectedness to nature. A mixed-method approach was used to evaluate the effectiveness of nature-based therapy for young psychosomatic patients. The results demonstrated improvements in mental well-being and connectedness to nature through therapy. Additionally, depression scores decreased. Patients reported the importance of the therapist setting the space, the supportive environment, the poems that fostered the nature connection, improvement at the soul level, and overall doing something meaningful. Every patient experienced nature-based therapy as effective. To conclude, the study gives a first insight into the processes of nature-based therapy in the German population at work and the effectiveness of nature-based therapy. Further questions, e.g., season effects, longitudinal effects, and whether patients with low connectedness to nature gain more out of the intervention remain unanswered.
... The outdoors is a place commonly utilized by adventure seekers and explorers; however, recent evidence suggests there is a relationship between contact with nature and an improvement in health and well-being [1][2][3][4][5][6][7]. These health benefits have been observed through the analysis of many physiological and psychological outcomes, primarily relating to stress and relaxation [1,8]. ...
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Heart rate variability (HRV) is a psychophysiological variable that is often used in applied analysis techniques to indicate health status because it provides a window into the intrinsic regulation of the autonomic nervous system. However, HRV data analysis methods are varied and complex, which has led to different approaches to data collection, analysis, and interpretation of results. Our scoping review aimed to explore the diverse use of HRV methods in studies designed to assess health outcomes in outdoor free-living contexts. Four database indexes were searched, which resulted in the identification of 17,505 candidate studies. There were 34 studies and eight systematic reviews that met the inclusion criteria. Just over half of the papers referenced the 1996 task force paper that outlined the standards of measurement and physiological interpretation of HRV data, with even fewer adhering to recommended HRV recording and analysis procedures. Most authors reported an increase in parasympathetic (n = 23) and a decrease in systematic nervous system activity (n = 20). Few studies mentioned methods-related limitations and challenges, despite a wide diversity of recording devices and analysis software used. We conclude our review with five recommendations for future research using HRV methods in outdoor and health-related contexts.
... Even before Covid-19 pandemic period, the role of urban green spaces (UGS) and urban and peri-urban forests in providing of major public health benefits has been carefully documented. Loss of UGS and trees is related to cardiovascular and lower-respiratory-tract illnesses (Donovan et al. 2013), while evidence shows that doing activities in the presence of nature it leads to positive short and longterm health outcomes, achieving good mental health, achieving potential, and coping well with stress and adversity (Barton & Pretty 2010). Psychology studies showed that simple and brief interactions with nature can produce marked increases in cognitive control and demonstrate the restorative value of nature as a pathway for improving cognitive functioning, concluding that nature must be recognized as fundamental for achieving effective cognitive functioning (Berman et al. 2009). ...
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Urban green spaces (public gardens, parks, urban and peri-urban forests) offer multiple-use opportunities and spaces for recreational activities and played a key role in supporting mental and physical health of dwellers during Covid-19 pandemic, being ones of few places where outdoor and social activities where allowed. This study was conducted in Brașov city (also known as Kronstadt, by its German name), the second largest metropolitan area of Romania and surrounded by a significant area of peri-urban forests in Transylvania. Brașov city own just 5.62 sqm of urban green space/inhabitant, one of the lowest in the country, so the presence of a large peri-urban forest area become very valuable for locals and tourists visiting the area. Due to its importance and because understanding visitors' expectations and perceptions is a key element to support decision-makers and ensure proper management of these forests, the Brașov’s forests administrator (Kronstadt Local Public Forest District – RPLPK) decided to investigate how dwellers generally interact with the peri-urban forests and to identify opportunities for improving the capacity of forests in providing social and recreational services. Data were collected through the administration of CAWI (computer assisted web interview) to 314 respondents at beginning of 2021, at exactly one year distance after the pandemic lockdown was imposed all around the country. Analyzing the participants responses, a surprising fact become evident: the use of peri-urban forest is not gender equal, women being less able than men to access these green natural spaces and, therefore, to uptake the benefits provided by the peri-urban forests.
... Mais à partir de combien de temps observe-t-on des bénéfices ? Une méta-analyse conclut qu'une exposition d'une durée de cinq minutes suffit pour provoquer une amélioration générale de l'humeur (Barton & Pretty, 2010 (Sarris & Mischoulon, 2017). ...
Les bienfaits des espaces de nature urbains sur la santé mentale sont attestés par de nombreuses publications scientifiques. Aujourd’hui, les recherches montrent que la diversité paysagère ainsi que les caractéristiques inter-individuelles induisent des effets différentiels sur la santé et le bien-être des usagers. L’objectif de cette thèse est de spécifier comment une expérience de nature bénéfique combine les composantes subjectives et environnementales. La recherche est menée à partir d’une expérience de nature in situ. Les comportements sont évalués par l’oculométrie, les cognitions avec l’entretien d’explicitation et les affects par le biais d’échelles psychométriques relatives à l’humeur et l’anxiété. Nos données objectivent un phénomène de restauration attentionnelle lors de cette expérience. La combinaison des approches psychologiques et paysagères renseigne qu’un paysage avec une faible verticalité et un champ visuel étendu favorise davantage la restauration. Enfin, nos analyses indiquent que le caractère thérapeutique de l’expérience de nature est lié à l’expérimentation d’états de pleine conscience. L’originalité de ce travail est de proposer une méthodologie mettant en évidence l’effet bénéfique de paysages contrastés Elle présente cependant des limites pour lesquelles des solutions sont proposées. Nos résultats suggèrent que l’expérience de nature constitue une véritable stratégie pour réduire l’anxiété et promouvoir l’euthymie en ramenant aux sensations présentes, c’est-à-dire à une expérience proche de la pleine conscience.
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The mental health crisis across college campuses is accelerating, with anxiety listed as the top mental health issue for undergraduate college students. Although evidence suggests the COVID-19 pandemic escalated the mental health crisis on college campuses, pre-COVID-19 anxiety among college students was on the rise. Research supports Mindfulness Based Interventions (MBIs) to reduce anxiety among college students. Additionally, exposure to natural environments, which are accessible to students on college campuses, is effective in reducing anxiety. While brief nature-based mindfulness interventions appear effective in reducing anxiety among college students, these interventions are often offered in isolation without social interaction among group members and lack intentional integration of mindfulness and nature-related theories. The purpose of this work is to describe a framework for integrating the use of Mindfulness and Attention Restoration Theory (ART) in an innovative psychoeducational group intervention, Nature-Based Mindfulness Training © (NBMT), for college students with anxiety. In conclusion, we argue for the need to intentionally integrate mindfulness and nature into nature-based mindfulness interventions as an effective and sustainable means to reduce anxiety. Limitations and areas for future research are described.
There is little empirical research into the benefits and experiences of coaching specifically in the outdoors. Attention Restoration Theory (ART) identifies four facets that explain why nature enables the brain to restore directed attention, improve cognitive capabilities and relieve stress. It is proposed that ART is relevant to understanding the benefits of outdoor coaching because, according to ART, natural environments can help the brain to focus more efficiently, make decisions, think creatively and process information effectively by restoring directed attention and cognitive capacity - all of which are aspects of high quality coaching conversations. The aim of the research is to identify the benefits of outdoor coaching experienced by the participants and analyse them using Attention Restoration Theory as a framework to explain these benefits. Data regarding the felt experiences of nine participants who are currently having, or recently had, outdoor coaching is analysed using Interpretative Phenomenological Analysis (IPA) and discussed. The key findings show six identified key themes linking the participants’ felt experiences with the four facets of ART: Being side-by-side; movement and pace; the perceived benefits of outdoors vs indoors; thinking differently; openness and expanse; senses, emotions and feelings. We conclude that there are benefits to taking coaching conversations outside and that ART is a framework that can explain these benefits.
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has always been a central consideration of urban planning. The premise of municipal (upheld by the US Supreme Court under Village of
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This article presents a framework for considering the relevance of the physical environment to obesity. The authors adopt the notion that the “environment” constitutes the space outside the person and therefore broaden the common conceptualization of the “environment” to encompass a full spectrum from small-scale design elements to large-scale community infrastructure. An energy balance approach is also adopted. The energy balance perspective recognizes the equilibrium of food consumption and energy expenditure, rather than focusing solely on one or the other side of the equation. The authors consider how environmental characteristics present either barriers (that hinder), or supports (that promote) healthy habits. Thus, they describe a range of obesity-related environmental themes that provide opportunities for innovative collaborative research between environmental psychologists and colleagues in fields ranging from apparel design to landscape architecture. Last, conceptual and methodological considerations are briefly presented.
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This paper examines connections between childhood involvement with the natural environment and adult environmentalism from a life course perspective. Approximately 2,000 adults age 18-90 living in urban areas throughout the United States were interviewed with respect to their childhood nature experiences and their current, adult attitudes and behaviors relating to the environment. Model testing and cross-validation procedures using structural equation modeling suggest that childhood participation with nature may set an individual on a trajectory toward adult environmentalism. Specifically, childhood participation in "wild" nature such as hiking or playing in the woods, camping, and hunting or fishing, as well as participation with "domesticated" nature such as picking flowers or produce, planting trees or seeds, and caring for plants in childhood have a positive relationship to adult environmental attitudes. "Wild nature" participation is also positively associated with environmental behaviors while "domesticated nature" experiences are marginally related to environmental behaviors.
This chapter describes the principles and methods used to carry out a meta-analysis for a comparison of two interventions for the main types of data encountered. A very common and simple version of the meta-analysis procedure is commonly referred to as the inverse-variance method. This approach is implemented in its most basic form in RevMan, and is used behind the scenes in many meta-analyses of both dichotomous and continuous data. Results may be expressed as count data when each participant may experience an event, and may experience it more than once. Count data may be analysed using methods for dichotomous data if the counts are dichotomized for each individual, continuous data and time-to-event data, as well as being analysed as rate data. Prediction intervals from random-effects meta-analyses are a useful device for presenting the extent of between-study variation. Sensitivity analyses should be used to examine whether overall findings are robust to potentially influential decisions.